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How to fill out pm 160 and chdp

How to Fill Out PM 160 and CHDP:

1. Start by gathering all the necessary information: To properly fill out the PM 160 (Claim for Health Care Services), you will need the patient's personal details, including their name, address, date of birth, and contact information. Additionally, you should have the patient's insurance information, such as the policy number and group number.
2. Fill in the healthcare provider's information: On the PM 160 form, there will be a section dedicated to the healthcare provider or facility's information. Provide the name, address, and contact details of the healthcare provider where the services were rendered.
3. Describe the services provided: In the "Description of Service" section, provide a clear and concise description of the healthcare services provided to the patient. Include details such as the date of service, the type of service rendered, and any relevant procedure or diagnosis codes.
4. Indicate the charges and fees: In the "Charges or Fees" section, specify the total charges for the services provided. Include any applicable deductibles, copayments, or coinsurance. If the patient has insurance coverage, indicate the amount that will be billed to the insurance company.
5. Attach supporting documents: If there are any supporting documents necessary to validate the services rendered, such as itemized bills or medical records, make sure to attach them securely to the PM 160 form. These documents can help expedite the processing and reimbursement of the claim.

Who needs PM 160 and CHDP?

1. Healthcare providers: PM 160 forms are primarily required by healthcare providers who offer services covered by Medi-Cal or California Children's Services (CCS). They use this form to submit claims for reimbursement for the services they have provided to eligible patients.
2. Patients with Medi-Cal or CCS coverage: Patients who have Medi-Cal or CCS coverage may also need the PM 160 form. If they receive healthcare services from providers who do not directly bill Medi-Cal or CCS, they might need to fill out the PM 160 form themselves and submit it for reimbursement.
3. Parents or legal guardians: In the case of children, parents or legal guardians may need to fill out the PM 160 form on their behalf. This is particularly relevant if the child has Medi-Cal or CCS coverage and receives services from providers who do not directly bill these programs.

Overall, the PM 160 and CHDP form are essential for healthcare providers and patients using Medi-Cal or CCS coverage to ensure proper reimbursement for services rendered and facilitate access to crucial healthcare services.

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